The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination
of persons aged 11–12 years to protect against certain diseases, including human papillomavirus
(HPV)–associated cancers, meningococcal disease, and pertussis (
1
). A booster dose of quadrivalent meningococcal conjugate vaccine (MenACWY) is recommended
at age 16 years, and serogroup B meningococcal vaccine (MenB) may be administered
to persons aged 16–23 years (
1
). To estimate vaccination coverage among adolescents in the United States, CDC analyzed
data from the 2018 National Immunization Survey–Teen (NIS-Teen) which included 18,700
adolescents aged 13–17 years.* During 2017–2018, coverage with ≥1 dose of HPV vaccine
increased from 65.5% to 68.1%, and the percentage of adolescents up-to-date
†
with the HPV vaccine series increased from 48.6% to 51.1%, although the increases
were only observed among males. Vaccination coverage increases were also observed
for ≥1 MenACWY dose (from 85.1% to 86.6%) and ≥2 MenACWY doses (from 44.3% to 50.8%).
Coverage with tetanus and reduced diphtheria toxoids and acellular pertussis vaccine
(Tdap) remained stable at 89%. Disparities in coverage by metropolitan statistical
area (MSA)
§
and health insurance status identified in previous years persisted (
2
). Coverage with ≥1 dose of HPV vaccine was higher among adolescents whose parents
reported receiving a provider recommendation; however, prevalence of parents reporting
receiving a recommendation for adolescent HPV vaccination varied by state (range = 60%–91%).
Supporting providers to give strong recommendations and effectively address parental
concerns remains a priority, especially in states and rural areas where provider recommendations
were less commonly reported.
NIS-Teen is an annual survey that monitors vaccines received by adolescents aged 13–17
years in the 50 states, the District of Columbia, selected local areas, and U.S. territories.
¶
NIS-Teen is conducted among parents and guardians of eligible adolescents identified
using a random-digit–dialed sample of cell phone numbers.** During the telephone interview,
information is obtained on the sociodemographic characteristics of the teen and household,
and contact information and consent to contact the teen’s vaccination providers are
requested. Vaccination providers identified during the interview are mailed a questionnaire
requesting the vaccination history from the teen’s medical record.
††
Vaccination coverage estimates are based on provider-reported vaccination histories.
This report presents vaccination coverage estimates for 18,700 adolescents (8,928
[48%] females and 9,772 [52%] males) aged 13–17 years with adequate provider data.
§§
The overall Council of American Survey Research Organizations response rate was 23.3%,
and only 48.3% of adolescents with completed interviews had adequate provider data.
Previously described NIS-Teen methodology, including methods for weighting and synthesizing
provider-reported vaccination histories (https://www.cdc.gov/vaccines/imz-managers/nis/downloads/NIS-TEEN-PUF17-DUG.pdf)
was used. Beginning in 2018, NIS-Teen used a single-frame sample of cell phone lines.
The landline telephone–sample frame that was used from 2006 through 2017 was dropped
because of the declining number of landline-only households in the United States (https://www.cdc.gov/vaccines/imz-managers/coverage/teenvaxview/pubs-presentations/dual-to-single-frame-teen.html).
Data were weighted and analyzed to account for the complex sampling design. T-tests
were used to assess vaccination coverage differences by survey year (2018 compared
with 2017) and between demographic subgroups. P-values <0.05 were considered statistically
significant. SAS-callable SUDAAN (version 11; SAS Institute) was used to conduct all
analyses.
National Vaccination Coverage
In 2018, 51.1% of adolescents aged 13–17 years were up to date with the HPV vaccine
series, and 68.1% had received ≥1 dose of HPV vaccine (Table 1) (Figure). During 2017–2018,
the increase in HPV vaccination coverage was attributable to increases among males
only (increase of 4.4 percentage points in males who were up to date versus 0.6 in
females). Coverage with ≥1 MenACWY dose increased by 1.5 percentage points to 86.6%.
Among persons aged 17 years, coverage with ≥2 MenACWY doses increased by 6.5 percentage
points to 50.8%. Coverage with ≥1 dose of MenB among persons aged 17 years was 17.2%
(95% confidence interval = 14.9%–19.9%). No significant increases were observed for
coverage with ≥3 hepatitis B doses; ≥2 measles, mumps, and rubella vaccine doses;
and ≥1 and ≥2 varicella vaccine doses among adolescents without a history of varicella
disease (Table 1).
TABLE 1
Estimated coverage with selected vaccines and doses among adolescents aged 13–17*
years, by age at interview — National Immunization Survey–Teen (NIS-Teen), United
States, 2018
Vaccine
Age at interview (yrs), % (95% CI)†
Total
13
14
15
16
17
2018
2017
(n = 3,852)
(n = 3,875)
(n = 3,741)
(n = 3,751)
(n = 3,481)
(n = 18,700)
(n = 20,949)
Tdap§ ≥1 dose
87.1 (85.0–89.0)
87.7 (85.4–89.7)
89.7 (87.8–91.4)
89.0 (87.1–90.6)
91.0 (89.5–92.4)¶
88.9 (88.0–89.7)
88.7 (87.8–89.6)
MenACWY**
≥1 dose
86.3 (84.2–88.1)
86.2 (84.0–88.1)
86.1 (83.7–88.2)
86.3 (84.0–88.3)
88.1 (86.3–89.6)
86.6 (85.6–87.5)††
85.1 (84.2–86.1)
≥2 doses
§§
NA
NA
NA
NA
50.8 (47.7–53.8)
50.8 (47.7–53.8)††
44.3 (41.4–47.2)
HPV¶¶ vaccine
All adolescents
UTD***
39.9 (37.0–42.9)
50.3 (47.3–53.2)¶
54.0 (51.0–56.9)¶
54.5 (51.5–57.5)¶
57.5 (54.4–60.5)¶
51.1 (49.8–52.5)††
48.6 (47.3–49.9)
≥1 dose
62.6 (59.7–65.4)
66.9 (64.1–69.6)¶
69.7 (66.9–72.3)¶
71.2 (68.5–73.8)¶
70.1 (67.3–72.8)¶
68.1 (66.8–69.3)††
65.5 (64.3–66.7)
Females
UTD
38.9 (35.0–42.9)
52.7 (48.5–56.8)¶
54.7 (50.4–59.0)¶
57.5 (53.3–61.6)¶
66.0 (61.8–70.1)¶
53.7 (51.8–55.6)
53.1 (51.2–55.0)
≥1 dose
61.1 (56.9–65.2)
68.6 (64.4–72.5)¶
70.7 (66.5–74.5)¶
73.5 (69.8–76.8)¶
76.3 (72.2–80.0)¶
69.9 (68.1–71.6)
68.6 (66.9–70.2)
Males
UTD
40.9 (36.5–45.3)
47.7 (43.6–51.8)¶
53.2 (49.1–57.3)¶
51.8 (47.5–56.1)¶
50.0 (45.7–54.3)¶
48.7 (46.8–50.6)††
44.3 (42.6–46.0)
≥1 dose
64.0 (59.9–67.9)
65.1 (61.3–68.7)
68.7 (65.0–72.1)
69.2 (65.2–73.0)
64.7 (60.7–68.5)
66.3 (64.6–68.0)††
62.6 (60.9–64.2)
MenB ≥1 dose†††
NA
NA
NA
NA
17.2 (14.9–19.9)
17.2 (14.9–19.9)
14.5 (12.3–17.1)
MMR ≥2 doses
93.5 (92.1–94.7)
93.0 (91.6–94.2)
91.8 (89.9–93.3)
90.5 (88.4–92.2)¶
90.9 (89.2–92.4)¶
91.9 (91.2–92.6)
92.1 (91.3–92.8)
Hepatitis B vaccine ≥3 doses
93.1 (91.5–94.5)
93.0 (91.5–94.3)
91.6 (89.1–93.5)
91.1 (89.3–92.6)
91.8 (90.1–93.2)
92.1 (91.3–92.8)
91.9 (91.1–92.6)
Varicella vaccine
History of varicella disease§§§
9.8 (8.1–11.9)
10.3 (8.5–12.4)
11.8 (10.0–13.9)
12.4 (10.7–14.3)
15.0 (13.2–17.1)¶
11.9 (11.0–12.7)††
13.2 (12.3–14.2)
No history of varicella disease
≥1 dose vaccine
95.4 (94.2–96.5)
95.4 (94.2–96.3)
94.1 (92.1–95.6)
94.3 (92.7–95.5)
95.2 (93.9–96.3)
94.9 (94.3–95.4)
95.5 (94.8–96.1)
≥2 doses vaccine
92.1 (90.5–93.4)
91.3 (89.6–92.8)
89.8 (87.4–91.8)
86.6 (84.3–88.7)¶
87.9 (85.4–90.1)¶
89.6 (88.7–90.4)
88.6 (87.6–89.5)
History of varicella or ≥2 vaccine doses
92.9 (91.4–94.1)
92.2 (90.6–93.5)
91.0 (88.9–92.7)
88.3 (86.2–90.1)¶
89.7 (87.5–91.6)¶
90.8 (90.0–91.6)
90.1 (89.3–90.9)
Abbreviations: CI = confidence interval; HPV = human papillomavirus; MenACWY = quadrivalent
meningococcal conjugate vaccine; MenB = serogroup B meningococcal vaccine; MMR = measles,
mumps, and rubella vaccine; NA = not applicable; Tdap = tetanus toxoid, reduced diphtheria
toxoid, and acellular pertussis vaccine; UTD = up-to-date.
* Adolescents (N = 18,700) in the 2018 NIS-Teen were born January 2000–February 2006.
† Estimates with 95% CIs >20 might be unreliable.
§ Includes percentages receiving Tdap vaccine at age ≥10 years.
¶ Statistically significant difference (p<0.05) in estimated vaccination coverage
by age; reference group was adolescents aged 13 years.
** Includes percentages receiving MenACWY or meningococcal-unknown type vaccine.
†† Statistically significant difference (p<0.05) compared with 2017 NIS-Teen estimates.
§§ ≥2 doses of MenACWY or meningococcal-unknown type vaccine. Calculated only among
adolescents who were aged 17 years at interview. Does not include adolescents who
received 1 dose of MenACWY vaccine at age ≥16 years.
¶¶ HPV vaccine, 9-valent (9vHPV), quadrivalent (4vHPV), or bivalent (2vHPV). Percentages
are reported among females and males combined (N = 18,700) and for females only (N
= 8,928) and males only (N = 9,772).
*** HPV UTD includes those with ≥3 doses, and those with 2 doses when the first HPV
vaccine dose was initiated at age <15 years, and there was at least 5 months minus
4 days between the first and second dose. This update to the HPV recommendation occurred
in December 2016 (https://www.cdc.gov/mmwr/volumes/65/wr/mm6549a5.htm).
††† ≥1 dose of MenB. Calculated only among adolescents aged 17 years at interview.
Administered based on individual clinical decision.
§§§ By parent/guardian report or provider records.
FIGURE
Estimated vaccination coverage with selected vaccines and doses* among adolescents
aged 13–17 years, by survey year and Advisory Committee on Immunization Practices
(ACIP) recommendations
†
— National Immunization Survey–Teen (NIS-Teen),
§
,
¶
United States, 2006–2018
Abbreviations: HPV = human papillomavirus vaccine; MenACWY = quadrivalent meningococcal
conjugate vaccine; Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular
pertussis vaccine; UTD = up-to-date.
* ≥1 dose Tdap at or after age 10 years; ≥1 dose MenACWY or meningococcal-unknown
type vaccine; ≥2 doses MenACWY or meningococcal-unknown type vaccine, calculated only
among adolescents aged 17 years at time of interview. Does not include adolescents
who received their first and only dose of MenACWY at or after age 16 years; HPV vaccine,
nine-valent (9vHPV), quadrivalent (4vHPV), or bivalent (2vHPV). HPV UTD includes those
with ≥3 doses and those with 2 doses when the first HPV vaccine dose was initiated
before age 15 years and at least 5 months minus 4 days elapsed between the first and
second dose.
† ACIP revised the recommended HPV vaccination schedule in late 2016. The recommendation
changed from a 3-dose to 2-dose series with appropriate spacing between receipt of
the first and second dose for immunocompetent adolescents initiating the series before
the 15th birthday. Three doses are still recommended for adolescents initiating the
series between the ages of 15 and 26 years. Because of the change in recommendation,
the graph includes estimates for ≥3 doses HPV from 2011 to 2015 and the HPV UTD estimate
from 2016 to 2018. The routine ACIP recommendation for HPV vaccination was made for
females in 2006 and for males in 2011. Because HPV vaccination was not recommended
for males until 2011, coverage for all adolescents was not measured before that year.
§ NIS-Teen implemented a revised adequate provider data definition (APD) in 2014 and
retrospectively applied the revised APD definition to 2013 data. Estimates using different
APD definitions might not be directly comparable.
¶ NIS-Teen moved from a dual landline and cell phone sampling frame to a single cell
phone sample frame in 2018, and estimates using 2017 data were calculated two ways,
using the dual frame and retrospectively using the single cell phone sampling frame.
The figure is a line chart showing the estimated vaccination coverage with selected
vaccines and doses among adolescents aged 13–17 years, by survey year and Advisory
Committee on Immunization Practices recommendations in the United States, during 2006–2018,
and using data from National Immunization Survey–Teen.
Vaccination Coverage by Selected Characteristics
Coverage for all measures of HPV and MenACWY vaccination and ≥2 varicella vaccine
doses among adolescents without a history of varicella disease were lower among adolescents
living in non-MSA areas than in those living in MSA principal cities (Table 2). The
largest differences were in HPV up-to-date status (15.4 percentage point difference)
and ≥2-dose MenACWY coverage (19.7 percentage point difference). Coverage differences
between adolescents living in MSA nonprincipal cities and MSA principal cities were
observed for HPV vaccination measures (5.3 and 7.0 percentage point differences for
receipt of ≥1 dose and being up-to-date, respectively) and ≥3 hepatitis B doses (1.7
percentage points). Compared with adolescents with private health insurance, those
with Medicaid had higher HPV vaccination coverage (8.8 and 5.5 percentage points higher
for receipt of ≥1 dose and being up-to-date, respectively) (Table 2). Uninsured adolescents
had lower vaccination coverage, with differences ranging from 4.4 percentage points
(≥1 varicella vaccine dose) to 18.7 percentage points (≥2 MenACWY doses) lower than
did adolescents with private insurance. Vaccination coverage estimates also differed
by race/ethnicity (Supplementary Table 1, https://stacks.cdc.gov/view/cdc/80676);
poverty level (Supplementary Table 2, https://stacks.cdc.gov/view/cdc/80677); and
jurisdiction (Supplementary Table 3, https://stacks.cdc.gov/view/cdc/80678). During
2014–2018, ≥1dose-HPV vaccination coverage increased an average of 4.4 percentage
points per year nationally. (Supplementary Table 4, https://stacks.cdc.gov/view/cdc/80679).
TABLE 2
Estimated vaccination coverage with selected vaccines and doses among adolescents*
aged 13–17 years by metropolitan statistical area
†
and health insurance status
§
— National Immunization Survey–Teen (NIS-Teen), United States, 2018
Vaccine
MSA% (95% CI)¶
Health insurance status % (95% CI)¶
Non-MSA
MSA nonprincipal city
MSA principal city
Private insurance only
Any Medicaid
Other insurance
Uninsured
(n = 3,593)
(n = 7,543)
(n = 7,564)
(n = 10,404)
(n = 5,999)
(n = 1,516)
(n = 781)
Tdap** ≥1 dose
86.8 (84.8–88.5)
89.7 (88.4–90.8)
88.6 (87.1–89.9)
90.1 (89.0–91.2)
88.2 (86.6–89.6)
††
85.6 (82.3–88.3)
††
85.1 (80.7–88.6)
††
MenACWY§§
≥1 dose
79.5 (77.3–81.6)
††
88.3 (87.1–89.4)
86.5 (84.7–88.0)
87.6 (86.4–88.8)
86.5 (84.8–88.0)
84.3 (81.1–87.0)
††
78.3 (72.7–83.0)
††
≥2 doses¶¶
34.6 (28.5–41.2)
††
51.5 (46.7–56.2)
54.3 (49.7–58.9)
52.8 (48.6–56.9)
52.4 (46.9–57.8)
38.6 (30.0–48.0)
††
34.1 (21.6–49.4)
††
HPV*** vaccine
UTD†††
40.7 (38.1–43.5)
††
49.1 (47.1–51.0)
††
56.1 (53.9–58.3)
50.2 (48.4–52.0)
55.7 (53.4–58.1)
††
45.1 (40.9–49.3)
††
35.5 (30.1–41.4)
††
≥1 dose
59.5 (56.8–62.2)
††
66.6 (64.8–68.4)
††
71.9 (69.8–73.9)
65.6 (63.8–67.3)
74.4 (72.3–76.3)
††
62.6 (58.5–66.5)
56.2 (50.1–62.2)
††
MMR ≥2 doses
90.1 (88.1–91.8)
92.3 (91.2–93.2)
92.0 (90.8–93.1)
92.8 (91.9–93.6)
92.0 (90.6–93.1)
90.1 (87.3–92.3)
††
84.2 (78.6–88.5)
††
Hepatitis B ≥3 vaccine doses
90.7 (88.8–92.4)
93.1 (92.1–94.0)
††
91.4 (89.9–92.6)
93.0 (91.9–93.9)
92.1 (90.8–93.3)
90.5 (87.8–92.6)
84.1 (78.5–88.4)
††
Varicella vaccine
History of varicella§§§
15.0 (13.1–17.0)
††
10.6 (9.6–11.8)
12.4 (10.9–14.0)
9.8 (8.8–10.9)
13.4 (11.8–15.1)
††
13.8 (11.1–17.1)
††
20.4 (16.2–25.4)
††
Among adolescents with no history of varicella disease
≥1 varicella vaccine dose
93.4 (91.5–94.9)
95.0 (94.1–95.8)
95.1 (94.0–96.0)
95.7 (94.9–96.3)
94.4 (93.2–95.4)
93.3 (90.7–95.1)
††
91.3 (86.0–94.7)
††
≥2 varicella vaccine doses
86.4 (84.1–88.4)
††
89.8 (88.3–91.1)
90.2 (88.8–91.4)
90.5 (89.3–91.7)
89.4 (87.8–90.8)
86.7 (83.4–89.4)
††
83.8 (77.6–88.5)
††
History of varicella or ≥2 vaccine doses
88.5 (86.5–90.2)
††
90.9 (89.6–92.0)
91.4 (90.1–92.5)
91.5 (90.3–92.5)
90.8 (89.4–92.1)
88.5 (85.6–90.9)
††
87.1 (82.0–90.9)
Abbreviations: CI = confidence interval; HPV = human papillomavirus; MenACWY = quadrivalent
meningococcal conjugate vaccine; MMR = measles, mumps, and rubella vaccine; MSA= metropolitan
statistical area; Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular
pertussis vaccine; UTD = up-to-date.
* Adolescents (N = 18,700) in the 2018 NIS-Teen were born January 2000–February 2006.
† MSA status was determined based on household-reported county of residence, and was
grouped into three categories: MSA principal city, MSA nonprincipal city, and non-MSA.
MSA and principal city were as defined by the U.S. Census Bureau (https://www.census.gov/programs-surveys/metro-micro.html).
Non-MSA areas include urban populations not located within an MSA as well as completely
rural areas.
§ Adolescents' health insurance status was reported by parent or guardian. “Other
insurance” includes the Children’s Health Insurance Program, military insurance, Indian
Health Service, and any other type of health insurance not mentioned elsewhere.
¶ Estimates with CIs >20 might be unreliable.
** Includes percentages receiving Tdap vaccine at age ≥10 years.
†† Statistically significant difference (p<0.05) in estimated vaccination coverage
by MSA or health insurance status. The referent groups were adolescents living in
MSA principal city areas and adolescents with private insurance only, respectively.
§§ Includes percentages receiving MenACWY and meningococcal-unknown type vaccine.
¶¶ ≥2 doses of MenACWY or meningococcal-unknown type vaccine. Calculated only among
adolescents aged 17 years at interview. Does not include adolescents who received
1 dose of MenACWY vaccine at age ≥16 years.
*** HPV vaccine, nine-valent (9vHPV), quadrivalent (4vHPV), or bivalent (2vHPV) in
females and males combined.
††† HPV UTD includes those with ≥3 doses, and those with 2 doses when the first HPV
vaccine dose was initiated at age <15 years, and there was at least 5 months minus
4 days between the first and second dose. This update to the HPV recommendation occurred
in December 2016 (https://www.cdc.gov/mmwr/volumes/65/wr/mm6549a5.htm).
§§§ By parent/guardian report or provider records.
Provider Recommendation for HPV Vaccination
Overall, 77.5% of parents reported receiving a provider recommendation for adolescent
HPV vaccination; prevalence varied by state, ranging from 59.5% in Mississippi to
90.7% in Massachusetts (Supplementary Figure, https://stacks.cdc.gov/view/cdc/80682)
(Supplementary Table 5, https://stacks.cdc.gov/view/cdc/80680). Nationally, ≥1-dose
HPV vaccination coverage was higher among adolescents whose parents reported receiving
a provider recommendation (74.7%) than among those whose parents reported not receiving
a provider recommendation (46.7%) (Supplementary Table 5, https://stacks.cdc.gov/view/cdc/80680).
Fewer parents living in non-MSA areas reported receiving a provider recommendation
than did those living in MSA principal cities (70.3% versus 77.4%) (Supplementary
Table 6, https://stacks.cdc.gov/view/cdc/80681).
Discussion
In 2018, U.S. adolescent vaccination coverage with ≥1 and ≥2 doses of MenACWY, ≥1
dose of HPV vaccine and being up-to-date with HPV vaccination continued to improve.
Coverage with ≥1 Tdap dose remains high but appears to have stabilized. Although HPV
vaccination coverage improved, increases among all adolescents were modest compared
with increases in previous years and were observed only among males. Since 2011,
¶¶
coverage has increased gradually among females and more rapidly among males. However,
only approximately half of adolescents have been fully vaccinated for HPV.
HPV vaccination coverage was higher among adolescents whose parent reported receiving
a provider recommendation. Thus, the provider recommendation continues to be a strong
predictor of HPV vaccination (
3
,
4
). However, even when a provider recommendation was given, only 75% accepted the vaccine,
suggesting that there are other reasons adolescents are not being vaccinated. Equipping
providers with the tools they need to give strong recommendations that emphasize the
importance of HPV vaccination in preventing cancer and effectively address parental
concerns is a priority, especially in states where provider recommendations were less
commonly reported. Resources on the importance of HPV vaccination and videos demonstrating
how to give a recommendation are available to facilitate discussion between providers,
teens, and their parents (https://www.cdc.gov/vaccines/vpd/hpv/hcp/resources.html).
Coverage disparities persisted for some vaccines by MSA status. The disparity in HPV
vaccination coverage by MSA status is not well understood; however, the lower prevalence
of provider recommendations in non-MSA areas might be a factor. In one study, parents
and guardians in the rural South indicated that they did not have enough information
on the vaccine or its purpose (
5
). Efforts to ensure that rural health care providers have the resources and training
necessary to educate parents and guardians about the benefits of HPV vaccination as
a cancer prevention tool might increase the number of adolescents protected against
diseases caused by HPV.
Vaccination coverage was significantly lower among uninsured adolescents than among
those with private insurance. Adolescents without health insurance are eligible to
receive vaccines through the Vaccines for Children (VFC) program.*** Lack of parental
awareness of (
6
) and misconceptions about the program, including that it is only for infants and
younger children, might serve as barriers (
7
). Increasing parental awareness and knowledge of the VFC program should improve vaccination
coverage among uninsured adolescents. Providers can assist by ensuring that their
health care practice routinely screen patients for eligibility and counsel families
about the VFC program.
The findings in this report are subject to at least seven limitations. First, the
overall Council of American Survey Research Organizations response rate was low, and
fewer than half of adolescents with completed interviews had adequate provider data.
Second, bias in estimates might remain even after adjustment for household and provider
nonresponse and landline-only and phoneless households.
†††
Third, changes in estimates of vaccination coverage from 2017 to 2018 should be interpreted
with caution, given the transition from dual landline- and cellular- to single-cellular
telephone-sampling frame in 2018. Fourth, estimates stratified by jurisdiction might
be unreliable because of small sample sizes. Fifth, multiple statistical tests were
conducted, and a small number might be significant because of chance alone. Sixth,
coverage with ≥2 doses of MenACWY and ≥1 dose of MenB might be underestimated because
MenB and second MenACWY dose may be administered at age >17 years (
1
), and NIS-Teen includes adolescents aged 13–17 years. Finally, the “provider recommendation”
variable is based on parental report and thus subject to recall bias.
It is encouraging that HPV vaccination coverage among boys continues to increase;
however, the lack of an increase among girls is concerning. In the United States,
an estimated 34,800 cases of cancer caused by HPV occur each year; 32,100 (92%), including
59% among women, would be preventable by the 9-valent HPV vaccine (
8
). Although, HPV vaccination has resulted in large declines in the prevalence of vaccine
type HPV infections among adolescent girls and young adults (
9
), as well as decreases in cervical precancers (
10
), continuing to improve HPV vaccination coverage for all adolescents, male and female,
will ensure they are protected from HPV infection and diseases caused by HPV, including
cancers.
Summary
What is already known about this topic?
Vaccines are recommended for adolescents to prevent diphtheria, pertussis, tetanus,
meningococcal disease, and cancers caused by human papillomavirus (HPV).
What is added by this report?
In 2018, adolescent vaccination coverage in the United States continued to improve
for meningococcal and HPV vaccines (primarily from increases among boys) and remains
high for tetanus and reduced diphtheria toxoids and acellular pertussis vaccine. Adolescents
whose parents reported having received a provider recommendation were more likely
to have received HPV vaccination compared with adolescents whose parents did not report
a provider recommendation.
What are the implications for public health care?
Providing parents and guardians with information and strong, high-quality recommendations
are valuable tools for improving HPV vaccination and preventing HPV infection and
diseases caused by HPV, including cancers.